Clinical Research
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 14, 2007; 13(14): 2077-2082
Published online Apr 14, 2007. doi: 10.3748/wjg.v13.i14.2077
Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration
Kazuya Akahoshi, Yorinobu Sumida, Noriaki Matsui, Masafumi Oya, Rie Akinaga, Masaru Kubokawa, Yasuaki Motomura, Kuniomi Honda, Masayuki Watanabe, Takashi Nagaie
Kazuya Akahoshi, Yorinobu Sumida, Noriaki Matsui, Masaru Kubokawa, Yasuaki Motomura, Kuniomi Honda, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Masafumi Oya, Rie Akinaga, Department of Pathology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
Masayuki Watanabe, Takashi Nagaie, Department of Surgery, Aso Iizuka Hospital, Iizuka, 820-8505, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Kazuya Akahoshi, MD, PhD, Department of Gastroenterology, Aso Iizuka Hospital, 3-83 Yoshio town, Iizuka 820-8505, Japan. kakahoshi2@aol.com
Telephone: +81-948-223800 Fax: +81-948-298747
Received: January 21, 2007
Revised: February 15, 2007
Accepted: February 20, 2007
Published online: April 14, 2007
Abstract

AIM: To evaluate the role of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) in the preoperative diagnosis of gastrointestinal stromal tumor (GIST).

METHODS: From September 2002 to June 2006, Fifty-three consecutive EUS-FNAs of GI tract subepithelial hypoechoic tumors with continuity to proper muscle layer suspected as GIST by standard EUS were evaluated prospectively. The reference standards for the final diagnosis were surgery (n = 31), or clinical follow-up (n = 22). Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens were compared.

RESULTS: In 2 cases puncture was not performed because of anatomical problems. The collection rate of adequate specimens from the GI tract subepithelial hypoechoic tumor with continuity to proper muscle layer was 82% (42/51). The diagnostic rate for the tumor less than 2 cm, 2 to 4 cm, and 4 cm or more were 71% (15/21), 86% (18/21), and 100% (9/9), respectively. In 29 surgically resected cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA using immunohistochemical analysis of GIST were 100% (24/24), 80% (4/5), 96% (24/25), 100% (4/4), and 97% (28/29), respectively. No major complications were encountered.

CONCLUSION: EUS-FNA with immunohistochemical analysis is a safe and accurate method in the prethera-peutic diagnosis of GIST. It should be taken into consideration in decision making, especially in early diagnosis following minimal invasive surgery for GIST.

Keywords: Gastrointestinal stromal tumor; Ultrasound-guided fine needle aspiration; Immunohistochemical analysis